I have back pain and an MRI showing a disc has herniated. Do I need surgery?
There are four reasons to seek a surgical solution:
Cauda Equina Syndrome, a disorder affecting a bundle of spinal nerve roots, which is extremely rare and requires urgent surgery. This syndrome includes back and leg pain, weakness and numbness, and may be associated with problems with bladder and bowel function.
Progressive strength loss. Many people have some strength loss, but if it is worsening, this would be an indication for surgery.
Intractable pain. If your pain cannot be controlled with medicine, injections, or therapy, then this too would be an indication for surgery.
Failure of conservative care. If a comprehensive program of physical therapy, medication, and/or injections has failed, then you might be a candidate for surgery.
What are my options if I don't want surgery?
There are a lot of options for non-surgical treatment of low back pain. The first is physical therapy. Good physical therapy will allow for the disc to heal and to provide improvements in biomechanics and strength. Recent studies have shown that directed physical therapy is more successful than more random approaches. Often, this is enough.
When the pain is too much to try physical therapy, however, epidural injections can also be very helpful.
Epidural injections are safe when compared to more invasive procedures. Complications include bleeding, headaches, infections, and very rarely, injury to a nerve. However, pain reduction can be markedly improved. Studies have shown excellent pain reduction and return to function with the use of epidural injections.
The combination of these two techniques can be the most effective treatment of all -- the epidural provides pain reduction and makes the physical therapy that much more successful.